Engaging student pharmacists to improve Hospital Consumer Assessment of Health Care Providers and Systems scores.

INTRODUCTION: Student pharmacists have historically served in shadowing roles for their experiential training at our institution. However, engaging students through active learning assignments has the potential to benefit both the student and the institution. The purpose of this project was to evaluate the impact of student pharmacists on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) scores, a direct reflection of patient satisfaction within the hospital. METHODS: In a four-month quality-improvement pilot project, student pharmacists were given active learning assignments directed at helping patients understand the purpose and side effects of their medications. Patients with hospital-initiated medications were provided with medication cards via student pharmacist-run counseling programs. The primary outcome was top response ("always") in medication-related HCAHPS scores. Secondary outcomes included scores on individual questions, number of medication education encounters, number of interventions, cost savings, and student feedback. RESULTS: There were 482 medication education encounters. The top response for all medication-related HCAHPS scores improved by 14% (49% to 63%). Top response regarding medication indication increased 23% (63% to 86%). There were 552 interventions accepted, projecting a savings of $135,658. The top score on student evaluations of the practice site increased 20% (69% to 89%). CONCLUSIONS: Student pharmacists can have a meaningful impact on medication-related HCAHPS scores. Additionally, student pharmacists benefit from active learning opportunities by providing and improving patient care leading to a more meaningful experience.

A curriculum in systems-based care: experiential learning changes in student knowledge and attitudes.

BACKGROUND: To provide efficient, quality patient care, physicians must have a fundamental understanding of how the health care delivery system functions and how to appropriately use the various components of this system. As part of the Undergraduate Medical Education for the 21st Century (UME-21) initiative, the University of Miami in partnership with AvMed Health Plans, a nonprofit managed care organization (MCO) developed a longitudinal educational program that prepares all students for medical practice in emerging systems of care. METHODS: The program, which spans the 4-year undergraduate curriculum, incorporates didactic sessions and practical experiences to teach about the clinical, managerial, financial, and ethical aspects of systems-based care. During the third year of medical school, students visit the administrative offices of AvMed Health Plans for a day-long series of presentation-discussions and experiential tours through the various administrative departments. There, they experience first-hand all facets of a systems-based approach to care using evidence-based practice guidelines, utilization review, quality measurement and improvement, and chronic disease management. RESULTS: An attitudinal survey, constructed to evaluate general attitudes toward managing care and MCOs, was administered to students at the beginning of their first, second, and third year and immediately before and after their visit to AvMed during their third year. Using factor analysis, there were no significant differences in students' attitudes at the beginning of the first, second, or third year nor immediately before the seminar day at the MCO. However, the day-long seminar at AvMed did have a favorable effect on attitudes toward systems of care and MCOs in general. In addition, students performed well on post-evaluation knowledge assessments addressing fundamental concepts of systems of care and the function of an MCO in managing the care of its members. The visit to the MCOs (AvMed) offices and the day-long curriculum was replicated at another medical school, with similar effects on students' attitudes. CONCLUSIONS: Medical students have neutral-to-negative opinions of systems of care and MCOs. Early educational experiences such as classroom lectures and panels that address managing care issues have minimal effect on these opinions. However, bringing medical students to an MCO's administrative offices, seeing first-hand how systems of care operate, and having an open dialogue with physician administrators does effect a positive change in medical student opinions of a system in which care is managed. In addition, medical students can gain new knowledge about effective systems-based practice.

Effect of a primary care physician-focused, population-based approach to blood pressure control.

BACKGROUND AND OBJECTIVES: A large majority of hypertensive patients are cared for in primary care settings, and most of them do not have adequately controlled blood pressure. AvMed Health Plan, a large Florida-based, nonprofit, physician network health maintenance organization, initiated a program to assist primary care physicians to achieve a greater degree of blood pressure control in their hypertensive patients. Concomitantly, a study was designed to determine whether this physician-focused intervention improved blood pressure control in these patients. METHODS: Data were collected from pharmacy claims and medical charts for random samples of treated hypertensive patients prior to and following a 6-month educational intervention aimed at providers. Analysis of the data sets was conducted to determine what percentage of subjects achieved target blood pressure goals before and after the intervention. RESULTS: At baseline, 41% of the total population had achieved a target blood pressure of <140/90 mm Hg; 52% achieved this goal following the intervention. When target blood pressure goals were defined as <140/90 mm Hg for nondiabetic subjects and < 130/85 mm Hg for diabetic subjects, 36% of the total population achieved target blood pressure goals at baseline; 47% achieved these goals following the intervention. CONCLUSIONS: A physician-focused intervention significantly improved blood pressure control in diabetic and nondiabetic hypertensive patients enrolled in AvMed Health Plan.